BROOKSVILLE — Dr. Gerard Romain, who improperly prescribed painkillers via the Internet, is no longer allowed to practice medicine in Florida. Yet patients of the Cosmopolitan Clinic could be excused for thinking he can.

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One of the names on the clinic's business cards is "Gerard Romain, M.D." A notice by the check-in window is signed "Dr. Romain."

There is no evidence that Romain is actually treating patients. But his affiliation with Cosmopolitan shows how hard it is to keep tabs on what happens inside doctors' offices.

Romain and his partner in the clinic, Robert Reppy, are among the nearly 200 Florida physicians whose cases the St. Petersburg Times reviewed as part of its investigation into prescription drug violations by doctors.

Hernando County Sheriff Richard Nugent said he was not familiar with Cosmopolitan Clinic, which has drawn complaints from nearby businesses about patients loitering outside.

But in the past year, Nugent said, the number of pain clinics in Hernando has swollen from 13 to more than 28 as Pinellas and Hillsborough counties cracked down on clinics in those areas.

"That's an alarming trend," Nugent said. "As they got pushed out of counties south of us, they have decided to move up here."

In 2006, Romain prescribed hydrocodone, a narcotic painkiller, to a California man over the Internet without meeting him or requesting a medical history. The man fatally overdosed on hydrocodone three months later.

In 2008, the Florida Board of Medicine fined Romain $20,000 and banned him from prescribing controlled drugs for a year. He faced further discipline last year for failing to pay the fine.

Romain closed his office in Winter Haven and relinquished his medical license in April.

Health department records show Romain's address to be the same as that of the Brooksville clinic. The clinic's cards have two names: Romain and Reppy. As of June, Reppy was one of Florida's top prescribers of the painkiller oxycodone to Medicaid patients, state records show.

Reppy, an osteopath, would not comment. Romain, a medical doctor trained in Haiti, did not respond to a certified letter seeking comment.

Last week, a Times reporter visited the clinic in a shabby medical plaza. Signs taped to the door told patients to wait in their cars and "not hang out in front of the office." Inside, a note signed by "Dr. Romain and staff'' offered patients $25 off their next visit if they referred a new patient to the clinic, a practice state regulations frown on.

When the reporter asked to speak with Romain, a woman behind the counter said he had retired and wasn't there.

When asked why signs and cards still bore his name, the woman said: "We need to change those."

Romain and other doctors who have lost their licenses can still use M.D. after their names, "but not if the context in which they are doing so would lead someone to believe they are a Florida-licensed medical doctor,'' said Eulinda Smith, a health department spokeswoman.

Although Romain can no longer practice medicine, he can own a clinic or work in one in a non-licensed capacity.

A Florida law that takes effect Friday forbids doctors who have lost their licenses from owning pain clinics. Another law already in effect requires pain clinics to register with the health department.

But Cosmopolitan doesn't call itself a pain clinic.

"There are clinics operating legitimately and then there are those that skirt the law,'' Nugent said. "I think state statutes went in the right direction, but they're just not strong enough.''

Times staff writer Tony Marrero contributed to this report. Susan Taylor Martin can be contacted at susan@sptimes.com.